POS0825 CLINICAL CHARACTERISTICS AND TREATMENT MANAGEMENT OF NON-INFECTIOUS SCLERITIS WITH CORTICOSTEROID-SPARING THERAPY. A RETROSPECTIVE STUDY FROM A TERTIARY EYE CARE CENTER.
Authors: J. Toutain, M. A. Gargouri, T. Chazal, S. Fares, I. Cochereau, E. Gabison, C. Titah, G. Clavel Refregiers
Journal: Annals of the Rheumatic Diseases (2022)

Background Non-infectious scleritis refers to a rare and sight-threatening scleral inflammation. An association with an underlying systemic disease is noted in 30% to 40% of cases. Their management may require the use of nonsteroidal anti-inflammatory drugs, oral corticosteroids, and sometimes steroid-sparing immunosuppressive agents. Because of the low incidence and prevalence of scleritis, treatment guidelines are currently not available. Objectives We analyzed in a retrospective observational study patients with scleritis referred to the Foundation Rothschild Hospital (Paris) from March 2011 to June 2021. Methods Characteristics, visual outcomes, ocular complications, associations with systemic diseases and efficacy of treatment were assessed in patients with non-infectious scleritis who needed steroid-sparing immunosuppressive agents. Results Among 731 patients diagnosed with scleritis, 54 patients (71 eyes, 7%) were treated by steroid-sparing immunosuppressive agents. Mean follow up was 111.9 ± 84.5 weeks. Mean age was 48.4 years ± 18.3, and 31 patients (57%) were female. Scleritis was anterior in 51 eyes (72 %), including 25 (35%) with diffuse scleritis, 24 (34%) with nodular scleritis and 2 (3%) with necrotizing scleritis. Scleritis was posterior in 20 eyes (28%). Bilateral involvement was noted in 17 patients (32 %). Ocular complications were observed in 52 eyes (73 %): scleral thinning in 25 eyes (35%), anterior uveitis in 24 eyes (34 %), loss of vision in 20 eyes (28%), posterior segment ocular complications in 18 eyes (25%), ocular hypertension in 17 eyes (24%) and corneal involvement in 16 eyes (23%). An underlying systemic disease was identified in 28 patients (52 %), and scleritis was the first manifestation of the systemic disease in 17 out of 28 patients. Rheumatoid arthritis was the most frequently identified disease (n=12), followed by granulomatosis with polyangiitis (n=8) and relapsing polychondritis (n=4). All patients received at least one immunosuppressive agent. Corticosteroid sparing with a daily dose ≤ 5 mg of prednisone was achieved in 85% of patients. Conventional immunosuppressive agents were used as the first steroid-sparing agent in 38 patients (70%) (methotrexate n=33, azathioprine n=4, mycofenolate mofetil (MMF) n=1) and as second steroid-sparing agent in 1 patient (MMF). This treatment led to control scleral inflammation in 23 (59%) patients after a mean delay of 10.0 ± 6.0 weeks. Biologic therapy was used in 33 (61%) patients (TNF alpha inhibitor n=17, IL6-R inhibitor n=7, anti-CD20 n=9), and as the first steroid-sparing agent in 16 (30%) (TNF alpha inhibitor n=4, IL6-R inhibitor n=4, anti-CD20 n=8). This treatment led to control scleral inflammation after a mean delay of 4,9 ± 3,7 weeks in 29 patients (87.9%). Conclusion Scleritis is a severe ocular inflammatory disease that requires repeated and thorough ophthalmologic and general examinations given the high frequency of complications and the possibility of an underlying systemic disease. This study reports real-life experience in management of non-infectious scleritis. Biological therapies seemed to be associated with a better outcome and a quicker reponse than conventional immunosuppressive agents. Further studies are warranted to develop specific guidelines Disclosure of Interests None declared